Diagnostic and therapeutic problems in heart failure.

Heart failure (HF), affecting an increasing number of patients, is associated with several diagnostic, therapeutic, socioeconomic problems. Despite considerable advances, prognosis in HF--both in systolic failure and in that with preserved systolic function--is poor, which in part results from not the fully understood pathophysiology of this disease, and therapeutic approaches used at present. Until recently, efforts of researchers focused on the development of effective therapeutic methods in more advanced stages of the disease, but their results were disappointing. Currently, more emphasis is placed on broadly understood methods of HF prevention. When starting HF treatment upon objective confirmation of the diagnosis, there are some primordial goals to be remembered, that if achieved, may translate into postponing the prospect of death and improving the patient's quality of life. Therapy of HF employs pharmaceuthical agents that reduce mortality (beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonists) and attenuate symptoms (diuretics, digoxin, inotropes). Intensification of therapy depends on the functional NYHA class. In recent years, fate of patients with advanced HF has improved through the use of electrotherapy (cardioverters-defibrillators and [or] resynchronization devices). The key issue is to develop a uniform model of healthcare for HF patients, focused on an outpatient clinic system rather than a hospital.